Coping for Injured Survivors Handbook

The information in this handbook is intended to help you understand your reactions to an act of terrorism or mass violence. You may or may not experience these reactions. This handbook is not intended to be a substitute for the role of professionals with expertise in counseling trauma victims.

Nothing in life can prepare you for the horror of an act of terrorism that robs you of your sense of security. No one expects such a thing to happen. Violent crime is an abnormal event, and terrorism is even more rare. The normal reactions to this type of traumatic disaster include a wide range of powerful feelings that may feel abnormal to the person having them or seem strange to people who have not gone through such a disaster. You may feel like something is wrong with you and that the terrible pain will never ease.

Recovering from a traumatic event will take a long time and will not be easy.

Everyone responds differently to trauma. No one is reacting in a right or wrong way—just differently. It will help your recovery process if you don’t expect too much of yourself and of others.

Reactions to a Traumatic Disaster

Shock and NumbnessAt first you may be in a state of shock. Feeling numb and confused are common. You may feel detached—as if you are watching a movie or having a bad dream that will not end. This numbness protects you from feeling the full impact of what has happened all at once.

Intense EmotionYou may feel overpowered by sorrow and grief. As shock begins to wear off, it is not unusual to feel intense grief and cry uncontrollably. While some parts of our society frown on emotional behavior, this emotional release is an important part of grieving for most people. It is unhealthy to hold back or “swallow” your painful feelings and can actually make the grief process last longer. A person who is uncomfortable with these feelings may want to seek help from a counselor, minister, or other victims who understand what you are experiencing.

FearYou may feel intense fear and startle easily, become extremely anxious when you leave your home or are alone, or experience waves of panic. You have been through a traumatic event. You had no time to prepare psychologically for such an incident, so you may feel intense anxiety and horror. You may be afraid that the terrorist will return and harm you or your loved ones again.

Crime shatters normal feelings of security and trust and the sense of being able to control events. Once you have been harmed by crime, it is natural to be afraid and suspicious of others. These feelings will go away or lessen over time.

GuiltVictims who were injured in a traumatic disaster want to understand why the crime happened, and families wonder why their loved one was injured.

Some people find it easier to accept what happened if they can blame themselves in some way. This is a normal way of trying to once again feel a sense of control over their lives. Victims often feel guilt and regret for things they did or did not say or do and that they should have protected themselves or a loved one better or have done something to prevent an injury or death.

Survivors spend a lot of time thinking “If only I had...”. This guilt does not make sense because the circumstances leading to terrorism usually cannot be controlled and are hard to predict. Get rid of imagined guilt. You did the best you could at the time. If you are convinced that you made mistakes or have real guilt, consider professional or spiritual counseling. You will need to find a way to forgive yourself. Guilt feelings can be made worse by people who point out what they would have done differently in the same situation. People who say such things are usually trying to convince themselves that such a tragedy could never happen to them.

Anger and ResentmentIt is natural for victims to be angry and outraged at the tragedy, the person or persons who caused the tragedy, or someone you believe could have prevented the crime. If a suspect is arrested, you might direct your anger toward that person. You may become angry with family members, friends, doctors, police, prosecutors, God, or even yourself and may resent well-meaning people who say hurtful things and do not understand what you—as a victim—are going through.

Feelings of anger may be very intense, and the feelings may come and go. You may also daydream about revenge, which is normal and can be helpful in releasing rage and frustration. Feelings of anger are a natural part of the recovery process. These feelings are not right or wrong; they are simply feelings. It is important to recognize the anger as real but to not use it as an excuse to abuse or hurt others. There are safe and healthy ways to express anger. Many people find that writing down their feelings, exercising, doing hard physical work, beating on a pillow, or crying or screaming in privacy helps them to release some of the anger. Ignoring feelings of anger and resentment may cause physical problems such as headaches, stomach upset, and high blood pressure. Anger that goes on a long time may cover up other more painful feelings such as guilt, sadness, and depression.

Depression and LonelinessDepression and loneliness are often a large part of trauma for victims. It may seem that these feelings will last forever. Trials are sometimes delayed for months and even years in our criminal justice system. The trial and any media coverage may result in having to relive the events surrounding the traumatic disaster. Feelings of depression and loneliness are even stronger when a victim feels that no one understands. This is the reason a support group for victims may be helpful; other victims will understand such feelings.

Victims of traumatic disaster may feel it is too painful to keep living and may think of suicide. If these thoughts continue, you must find help. Danger signals to watch for include: (1) thinking about suicide often; (2) being alone too much; (3) not being able to talk to other people about what you are feeling; (4) sudden changes in weight; (5) continued trouble sleeping; and (6) using too much alcohol or other drugs (including prescription drugs).

IsolationYou may feel that you are different from everyone else and that others have abandoned you. Terrorism is an abnormal and unthinkable act, and people are horrified by it. Other people may care but still find it hard or uncomfortable to be around you. You are a reminder that terrorism can happen to anyone. They also cannot understand why you feel and act the way you do, because they have not gone through it.

Physical Symptoms of DistressIt is common to have headaches, fatigue, nausea, sleeplessness, loss of sexual feelings, and weight gain or loss during the experience of a traumatic event. Also, you may experience lower-back aches, chills/sweats, twitch/shakes, feel uncoordinated, and/or grind your teeth.

PanicFeelings of panic are common and can be hard to cope with. You may feel like you are going crazy. Often, this feeling happens because traumatic disasters like terrorism seem unreal and incomprehensible. Your feelings may be so strong and overwhelming that they frighten you. It can help a great deal to talk with other victims who have had similar feelings and truly understand what these feelings are all about.

Inability to Resume Normal ActivityYou may find that you are unable to function the way you did before the act of terrorism and to return to even the simplest activities. It may be hard to think and plan, life can seem flat and empty, and the things that used to be enjoyable now seem meaningless. You may not be able to laugh, and then when you finally do, you feel guilty. Tears come often and without warning. Mood swings, irritability, dreams and flashbacks about the crime are common.

These feelings may come for months after the disaster. Your friends and co-workers may not understand the feelings that come with this type of experience and the length of time you will need to recover. They may simply think it is time for you to put the disaster behind you and get on with normal life. Trust your own feelings and travel the hard road to recovery at your own pace.

Delayed ReactionSome individuals experience no immediate reaction. They may be energized by a stressful situation and not react until weeks or months later. This type of delayed reaction is not unusual and, if you begin to have some of the feelings previously discussed, you should consider talking with a professional counselor.

Practical Coping Ideas

Other victims and survivors of traumatic disasters who have been where you are offer some practical suggestions of things you can do that will help you cope and begin to heal:

Remember to breathe. Sometimes when people are afraid or very upset, they stop breathing. When you are scared or upset, close your eyes and take deep, slow breaths until you feel calmer. Taking a walk or talking to a close friend can also help.

Whenever possible, delay making any major decisions. You may think a big change will make you feel better, but it will not necessarily ease the pain. Give yourself time to get through the most hectic times and to adjust before making decisions that will affect the rest of your life.

Simplify your life for a while. Make a list of the things you are responsible for in your life, such as taking care of the kids, buying groceries, teaching Sunday School, or going to work. Then, look at your list and see which things are absolutely necessary. Is there anything you can put aside for awhile? Are there things you can let go of completely?

Take care of your mind and body. Eat healthy food. Exercise regularly, even if it is only a long walk every day. Exercise will help lift depression and help you sleep better, too. Massage can also help release tension and comfort you.

Avoid using alcohol and other drugs. These substances may temporarily block the pain, but they will keep you from healing. You have to experience your feelings and look clearly at your life to recover from tragedy.

Keep the phone number of a good friend nearby to call when you feel overwhelmed or have a panic attack.

Talk to a counselor, clergy member, friend, family member, or other survivors about what happened. It is common to want to share your experience over and over again—and it can be helpful for you to do so.

Begin to restore order in your world by re-establishing old routines at work, home, or school as much as possible. Stay busy with work that occupies your mind, but avoid throwing yourself into frantic activity.

Ask questions. You may have concerns about what types of assistance are available, who will pay for your travel and other expenses, and other issues concerning compensation and insurance. Find out what will be expected of you in the days to come, so you can plan ahead for any new or stressful circumstances.

Talk to your children, who are often the invisible victims of these crimes, and make sure they are part of your reactions, activities, and plans.

Organize and plan how you will deal with the media. It may be helpful to include family, friends, or other victims or survivors in your planning process. You do NOT have to speak to the media. It is your decision how much, if any, involvement you have with the media. Any contact should be on your terms.

Seek the help of a reputable attorney. Take time to make decisions about insurance settlements, legal actions, and other matters that have long-term consequences.

Rely on people you trust. Seek information, advice, and help from them. Remember that while most people are honest and trustworthy, some unscrupulous individuals try to take advantage of victims in the aftermath of a disaster.

Avoid doing upsetting things right before bed if you are having trouble sleeping. Give yourself 30 minutes earlier in the day as your “worry time.” Write down your fears and nightmares. Put on quiet music or relaxation tapes. If you still can’t sleep, do not get mad at yourself and worry about not getting sleep. You can still rest by lying quietly and listening to relaxing music or by reading a good book. If your sleeping problems continue, you may want to see your doctor.

Find small ways to help others, as it will help ease your own suffering.

Ask for help from family, friends, or professionals when you need it. Healing grief and loss is similar to healing your body after illness or an accident. Just as there are doctors and nurses who are trained to help heal the body, there are professionals who are trained to help people recover from loss and cope with emotional pain.

Think about the things that give you hope. Make a list of these things and turn to them on bad days.

It is important to remember that emotional pain is not endless. It does have limits. The pain will eventually ease, and the joys of life will return. There will be an ebb and flow to your grief. When it is there, let yourself feel it. When it is gone, let it go. You are not responsible or obligated to keep the pain alive. Smiles, laughter and the ability to feel joy in the good things of life will return in time.

Victims are forever changed by the experience of terrorism. They realize that although things will never be the same, they can face life with new understanding and new meaning. Many things have been lost, but many things remain. Overcoming even the greatest tragedies is possible and can help bring about change and hope for others.

Finding Help

Whatever you are facing or feeling at the moment, it is important to remember that each person copes with tragedy in his or her own way. Trust your own feeling and that it is normal. Do not act like things are fine when they are not. Healing begins by talking about what happened with people you trust—people who support you without being judgmental or giving unwanted advice about what you should do or how you should feel.

Most people find it helpful to talk with a professional counselor who has worked with other crime survivors. Sometimes just a few sessions with a trained counselor will help you resolve the anger, guilt, and despair that keep you from recovering. Also, talking with other violent crime victims may help you feel better understood and less alone.

If you feel overwhelmed by your emotions and think you may hurt yourself or others, immediately ask for support and guidance from family, friends, a minister, or a professional counselor. Your physician may be able to refer you to a professional counselor.

You can contact the FBI Office for Victim Assistance at 1-866-828-5320 or by sending an e-mail to victim.assistance@ic.fbi.gov for a list of victim assistance programs in your area.

Many victims of terrorism have walked this long road before you. They have honored us by sharing with us the memories of their loved ones, the experience of their suffering, and their recommendations for helping future victims.

Those of us in the FBI have not shared your experience, but we can assure you that we will do our best to assist you as we work to bring the perpetrators to justice.

Preparation of this brochure was supported in part by the Office for Victims of Crime, Office of Justice Programs, and the U.S. Department of Justice. The opinions, findings and conclusions expressed in this brochure are of the author(s) and do not necessarily represent the official position or policies of the U.S. Department of Justice.